Bio Retinoid Safety During Pregnancy: What's The Verdict?

If you're pregnant, it's recommended that you avoid retinoids altogether. Oral and topical retinoids are linked to a range of pregnancy-related problems that can affect the growth of a baby.

Retinoids are a class of vitamin A derivatives commonly used in skincare products to treat various skin conditions, including acne and signs of ageing. They have been a staple of skincare regimes since the 1970s.

Retinoids can have a teratogenic effect on a pregnancy, meaning they can harm a developing foetus. High doses of retinol or retinoids in pregnancy are linked to foetal retinoid syndrome, also known as retinoic acid embryopathy. Studies indicate that excessive vitamin A exposure during pregnancy may disrupt normal foetal development, potentially leading to malformations of the central nervous system, heart, and other vital organs.

It's excessive vitamin A intake that can harm your baby. While vitamin A is essential for the development of the foetus, getting too much can cause serious birth defects and liver toxicity.

Oral retinoids and foetal retinoid syndrome

Oral retinoids are drugs used to treat severe skin conditions that are resistant to other therapies. They are also used to treat severe acne. The best-known oral retinoid is isotretinoin (Roaccutane).

Oral retinoids are known to cause foetal malformations if taken during pregnancy. The risk of foetal malformation is extremely high even when used at low doses or for a short time during pregnancy. They can cause birth defects in the early weeks of pregnancy, even before a woman knows she is pregnant. It is estimated that 20-35% of foetuses exposed to retinoids during pregnancy will develop birth defects.

Foetal retinoid syndrome is a condition that can develop in a baby that has been exposed to retinoids during pregnancy. It is characterised by a pattern of physical birth defects and a range of physical and mental developmental issues that can vary from mild to severe. Birth defects associated with foetal retinoid syndrome include:

• Growth delay
• Excess fluid around the brain (hydrocephalus)
• Abnormally small head size (microcephaly)
• Intellectual and learning disabilities
• Ear and eye abnormalities
• Cleft palate and other facial differences
• Heart defects

There is no treatment for foetal retinoid syndrome. Babies born with this condition are treated based on their symptoms. To avoid the risk of foetal retinoid syndrome, women who are considering getting pregnant or are pregnant should not take oral retinoids. Public health programs exist to help reduce the chance that a woman will use retinoids if she is considering getting pregnant.

Topical retinoids and pregnancy

Topical retinoids are prescription creams or lotions that are used to treat acne and as an anti-aging treatment. They are derived from vitamin A, which is essential for fetal growth and supports fetal eye health, the immune system, and skeletal growth. However, high amounts of vitamin A are dangerous for pregnant people and can lead to birth defects and intellectual and developmental disabilities in the baby.

While the safety of topical retinoids during pregnancy is not fully understood, it is recommended that pregnant people avoid using them out of an abundance of caution. This is because even though topical retinoids are applied to the skin, a small amount is still absorbed into the body through the skin. The risk of harm to the fetus is generally lower with topical retinoids than with oral retinoids, which are taken by mouth and easily enter the bloodstream at higher levels.

There have been a few reports of babies born with birth defects to mothers who used topical retinoids during pregnancy. These birth defects are similar to those seen in babies exposed to isotretinoin, an oral retinoid known to cause birth defects. However, the majority of individuals who have used topical retinoids during pregnancy have not had babies with birth defects, so the chance of defects is probably low.

Overall, it is generally recommended that pregnant people avoid using topical retinoids during pregnancy and while breastfeeding. There are alternative skincare products that are safer to use during pregnancy, such as topical benzoyl peroxide and salicylic acid, as well as over-the-counter retinol-based products, which have lower levels of retinoids.

Safe alternatives to retinoids during pregnancy

While retinoids are not safe to use during pregnancy, there are several safe alternatives that can be used to achieve similar skincare results.

Vitamin C

Vitamin C is a powerful antioxidant that helps protect the skin against UV damage and free radicals. It also stimulates collagen production, improves skin discoloration, and boosts the skin's ability to heal from sun exposure.

Peptides

Peptides are chains of amino acids that help give the skin the building blocks for collagen, which reduces fine lines and wrinkles. Recent research has shown that certain peptide formulations can produce a "Botox-like effect."

Bakuchiol

Derived from the Indian psoralea corylifolia plant, bakuchiol has been shown to activate several chemical pathways in skin cells that lead to improved collagen production, decreased collagen breakdown, and reduced melanin synthesis. This results in an improvement in fine lines, wrinkles, and pigmentation associated with the natural ageing process.

Rosehip Oil

Rosehip oil is not a retinoid but offers some skin benefits due to its richness in beta-carotene, vitamin C, and vitamin E.

Glycolic Acid

Glycolic acid is an alpha-hydroxy acid that exfoliates the skin and has anti-acne properties.

Azelaic Acid

Azelaic acid is another acne treatment with anti-inflammatory and antimicrobial properties.

Hyaluronic Acid

Hyaluronic acid helps reduce wrinkles and hydrates the skin.

Natural Moisturizers

All-natural moisturisers with ingredients like green tea, aloe vera, and shea butter can help keep the skin soft and moisturised during pregnancy.

It is important to read the ingredients list on every product and consult a doctor or dermatologist to ensure the products are safe for your individual needs during pregnancy.

Retinoids and breastfeeding

Retinoids are a type of vitamin A that speed up cell division, quickening the skin's renewal and preventing skin collagen from breaking down. They are often used to reduce the appearance of fine lines and wrinkles and rejuvenate skin.

However, retinoids are one of the skincare ingredients that experts recommend pregnant and breastfeeding women stay away from. This is because retinoids have been shown to cause birth defects, and there is a risk that they could be passed to your child through your milk.

Topical retinoids haven't been studied in breastfeeding women, so medical professionals usually caution against using them while breastfeeding. The FDA lists topical retinoids as "category C" during pregnancy, meaning animal studies have shown risks to the fetus.

Oral retinoids, such as isotretinoin, are known to cause birth defects and are therefore not recommended during pregnancy or breastfeeding.

While there is less chance of the active ingredients in topical retinoids getting into your blood, it is still recommended that you avoid them during pregnancy and while breastfeeding.

Over-the-counter retinol-based skincare products are likely safer during pregnancy and breastfeeding. They are nowhere near as strong as prescription retinoid creams or lotions. However, it is still recommended that you consult your doctor before using any retinol products while breastfeeding.

If you are breastfeeding and want to avoid retinol altogether, there are many alternatives that can help improve your skin's texture and appearance. These include Vitamin C and Bakuchiol, which can be found in many natural products.

Other ingredients to avoid during pregnancy

While most over-the-counter body care products are safe, there are a few ingredients that could be harmful to your baby. Here is a list of ingredients to avoid during pregnancy:

• Vitamin A derivatives such as Retin-A, retinol, and retinyl palmitate. While vitamin A is important for your baby's development, excessive amounts can lead to dangerous birth defects.
• Tazorac and Accutane are prescription medicines derived from vitamin A that are known to cause birth defects.
• Benzoyl peroxide and salicylic acids are common ingredients in acne creams. While lower-dose topical products are considered safe, it is best to choose acne creams that only use one of these ingredients.
• Essential oils are not assessed by the FDA and do not have strict labelling standards. Several varieties have been linked to major health concerns during pregnancy.
• Hydroquinone is a common skin lightener that has a higher absorption rate than other topical chemicals, making it more likely to enter the bloodstream and affect your baby.
• Aluminum chloride is a common ingredient in deodorants and antiperspirants that has been linked to fertility problems. While it is generally considered safe in lower concentrations, it is best to avoid products that use it in high concentrations.
• Formaldehyde is a known carcinogen that has been linked to an increased risk of infertility and miscarriage. It is rarely used as a preservative and disinfectant in beauty products, but there are formaldehyde-releasing chemicals commonly found in cosmetics that have a similar effect.
• Oxybenzone and avobenzone are the most frequently used ultraviolet (UV) filters in sunscreens. They have been linked to negative health and environmental effects, including endocrine disruption, and can interfere with your baby's nervous system development.
• Tetracycline and its derivatives (doxycycline and minocycline) are common antibiotics used to treat skin conditions, but studies have shown negative effects on both pregnant mothers and their babies.
• Dihydroxyacetone is a chemical used in spray self-tanners that can be inhaled during application, which is unhealthy for both mother and baby.

Frequently asked questions